To assess the perspectives of Bangladeshi teachers on the feasibility of delivery and potential for long-term sustainability of puberty and menstruation education in urban and rural schools.We deve...

Background: In low to middle-income countries where home births are common and neonatal postnatal care is limited, community health worker (CHW) home visits can extend the capability of health systems to reach vulnerable newborns in the postnatal period. CHW assessment of newborn danger signs supported by mHealth have the potential to improve the quality of danger sign assessments and reduce CHW training requirements. We aim to estimate the validity (sensitivity, specificity, positive and negative predictive value) of CHW assessment of newborn infants aided by mHealth compared to physician assessment. Methods: In this prospective study, ten CHWs received five days of theoretical and hands-on training on the physical assessment of newborns including ten danger signs. CHWs assessed 273 newborn infants for danger signs within 48 h of birth and then consecutively for three days. A physician repeated 20% (n = 148) of the assessments conducted by CHWs. Both CHWs and the physician evaluated newborns for ten danger signs and decided on referral. We used the physician’s danger sign identification and referral decision as the gold standard to validate CHWs’ identification of danger signs and referral decisions. Results: The referrals made by the CHWs had high sensitivity (93.3%), specificity (96.2%), and almost perfect agreement (K = 0.80) with the referrals made by the physician. CHW identification of all the danger signs except hypothermia showed moderate to high sensitivity (66.7–100%) compared to physician assessments. All the danger signs assessments except hypothermia showed moderate to high positive predictive value (PPV) (50–100%) and excellent negative predictive value (NPV) (99–100%). Specificity was high (99–100%) for all ten danger signs. Conclusion: CHW's identification of neonatal danger signs aided by mHealth showed moderate to high validity in comparison to physician assessments. mHealth platforms may reduce CHW training requirements and while maintaining quality CHW physical assessment performance extending the ability of health systems to provide neonatal postnatal care in low-resource communities. Trial registration: clinicaltrials.gov NCT03933423, January 05, 2019.

The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh. We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes. Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time. This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

Background: e-Waste is a rapidly growing waste stream worldwide, and Bangladesh is a hub of e-waste handling. Informal e-waste recycling operations involve crude methods for dismantling, repairing, sorting, and recycling electronic goods with bare hands and without personal health protections. Direct inhalation or dermal exposure to toxicants during informal recycling is common. Evidence suggests that e-waste–derived toxicants pollute the terrestrial ecosystem and have been linked with adverse health effects. However, e-waste recycling–related occupational health hazards have not been adequately explored in the context of Bangladesh. Objective: Our study aims to expand the current understanding of exposure to e-waste. This study will measure the metal concentrations in biological and environmental samples and evaluate the relationship between heavy metals and the biochemical systems of the e-waste workers. Methods: The study uses a cross-sectional study design consisting of an exposed site and a nonexposed control site. The trained team collected information on individual exposures, detailed work and medical history, and biological samples (blood, urine, and hair) from each subject. This study will measure heavy metal levels (lead, cadmium, and mercury) and biochemical parameters (hematological, hormonal, renal, and others) from the biological samples with reported physical function as outcomes of interest. In addition, we also collected soil and dust samples from both exposed and nonexposed control sites to measure the health risk. All the environmental samples will be analyzed using inductively coupled plasma mass spectrometer to determine metal concentrations. We will also conduct a qualitative investigation for a deeper understanding of the e-waste management system in Bangladesh. Results: The protocol has been approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh, and The University of Queensland’s Human Behavioral Ethics Committee. Informed written consent was obtained from all participants. We recruited 199 workers from the e-waste sites with at least 5 years of exposure and 104 control subjects with no industrial or e-waste exposure. Sample analysis is estimated to be completed in 2022. Conclusions: Although many studies have identified potential adverse health outcomes from exposure to e-waste, there is a lack of published epidemiological research in Bangladesh. Research in this field is particularly pressing in the context of the current e-waste trend and the need to deepen the understanding of exposures and outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/38201

Seasonal meteorological variations influence the spread of infectious diseases. Wastewater surveillance helps understanding pathogen transmission dynamics, particularly in urban areas of climate-vulnerable countries like Bangladesh. We analysed 54 weeks of wastewater surveillance, clinical surveillance, and meteorological data from Dhaka, Bangladesh. Samples from 11 sites were tested for Vibrio cholerae (V. cholerae), SARS-CoV-2, Salmonella enterica subspecies enterica serovar Typhi (S. Typhi), and Group A rotavirus. Diarrhoeal Disease Surveillance data were sourced from icddr,b, and meteorological data from the Bangladesh Meteorological Department. Regression models adjusted for site and time variations were used for statistical analysis. Proportion of confirmed cholera cases among the diarrhoeal disease surveillance recruits were highest during post-monsoon (coef: 2.53; 95 % CI: 0.41 to 4.67; p = 0.029). V. cholerae log10 concentrations in wastewater were positively associated with pre-monsoon (coef: 0.93; 95 % CI: 0.26 to 1.58; p = 0.010), while SARS-CoV-2 peaked during monsoon (coef: 1.85; 95 % CI: 0.96 to 2.73; p < 0.001). S. Typhi and rotavirus log10 concentrations showed negative associations with pre-monsoon (coef: -0.96; 95 % CI: -1.68 to -0.27; p = 0.011, and -0.84; 95 % CI: -1.17 to -0.50; p < 0.001, respectively). Temperature positively influenced log10 concentrations of V. cholerae (adj. coef: 0.09; 95 % CI: 0.02 to 0.15; p = 0.014) and SARS-CoV-2 (adj. coef: 0.19; 95 % CI: 0.10 to 0.27; p < 0.001), but negatively associated with rotavirus (adj. coef: -0.06; 95 % CI: -0.10 to -0.03; p < 0.001). Similar associations were found between pathogen-positive samples and temperature. Our study shows that seasonal, and meteorological factors (particularly temperature) influence the patterns and abundance of pathogens in wastewater and help in understanding disease transmission across different weather patterns.

In low- and middle-income countries like Bangladesh, inadequate water, sanitation, and hygiene (WASH) practices lead to a higher disease burden among children and hinder their academic performance. However, there have been efforts to improve WASH between 2014 and 2018. The study aimed to investigate changes in WASH facilities and practices in Bangladeshi schools from 2014 to 2018. We analyzed pooled data from Bangladesh National Hygiene Survey 2014 and 2018. We performed descriptive analysis, bivariate analysis, and multivariate Generalized Estimating Equation (GEE) to analyze the changes over the four years time period. Results showed that basic drinking water services increased from 78% in 2014 to 90% in 2018. Schools showed a significant increase in basic sanitation services from 19% in 2014 to 52% in 2018. We discovered that students’ access to water and soap increased from 2014 to 2018, from 21% to 35%. In the GEE model, we found that change in time, non govt urban schools were associated factors with improved basic drinking water services. For basic sanitation services, changes in time, school type and area type were significantly associated higher services. And for basic hygiene services, the associated factors were: schools having hygiene promotion visits, and availability of hygiene brigades at schools managed by students. WASH services in Bangladeshi schools have improved significantly, yet disparities exist, particularly in government and rural schools. Although students’ knowledge improved, their practices still need improvements through training on proper WASH practices.